Provider Demographics
NPI:1154874386
Name:SILADI, KRISTINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SILADI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W 21ST ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4613
Mailing Address - Country:US
Mailing Address - Phone:203-417-0686
Mailing Address - Fax:
Practice Address - Street 1:2001 N DUSTIN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2120
Practice Address - Country:US
Practice Address - Phone:505-324-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist